Sep 13 Fall 05 Electronic Medical Records (EMR) Computerized Patient Record (CPR) Electronic Health Record (EHR)

Sep 13 Fall 05 Work-out Problem 1 Assume that disease D1 has a prevalence of 10% in Milwaukee (population 600,000) Test T1 has a sensitivity of 80% and a specificity of 90% for D1 Calculate –The positive predictive value of T1 –The negative predictive value of T1

Sep 13 Fall 05 Work-out Problem 2 Assume that disease D2 has a prevalence of 0.01% in Milwaukee (population 600,000) Test T2 has a sensitivity of 80% and a specificity of 90% for D2 Calculate –The positive predictive value of T2 –The negative predictive value of T2

Sep 13 Fall 05 Patient Record The patient record is a representation of all the data acquired and created when the patient navigates through the health care system

Sep 13 Fall 05 Use of a Patient Record To recall observations To inform others To instruct students Gain knowledge Monitor performance Justify interventions In short, to improve health care delivery

Sep 13 Fall 05 EMR A repository of electronically maintained information about an individual’s lifetime health status and health care. It should be accessible to multiple legitimate users.

Sep 13 Fall 05 EMR… Adds information management tools Clinical reminders and alerts Links to literature Health care decision support Analysis of aggregate data

Sep 13 Fall 05 How EMR Differs from a Paper Record EMR flexible and adaptable Care for a single patient or groups of patients (guidelines) All authorized persons can access data immediately based on need Possible remote access Better documentation and legibility

Sep 13 Fall 05 Factors Influencing EMR Usefulness Comprehensiveness of information Duration of use and data retention Structure of data Ubiquity of access

Sep 13 Fall 05 Disadvantages of EMR Initial cost –Hardware –Software –Training –Support Failures Data input issues

Sep 13 Fall 05 Functional Components of EMR Integrated view of patient data –Providers need many views Clinical decision support Clinician order entry Access to knowledge resources

Sep 13 Fall 05 EMR: Input and Output Patient Database Database Interface Radiology Pharmacy Laboratory Order Entry Data Entry & Results Review Event Monitor Medical Logic Modules Billing & Finance Research Databases Medical Entities Dictionary Modified from Shortliffe etal. 01

Sep 13 Fall 05 Clinical Decision Support Most effective when the physician is assessing the patient’s condition and is making ordering decisions –Override option required –Rationale for suggestion helpful Anti-microbial assistance has resulted in significantly improved clinical and financial outcomes for patients

Sep 13 Fall 05 Access to Knowledge Resources The most effective time to provide access to knowledge resources is at the time decisions or orders are being contemplated by the physician

Sep 13 Fall 05 Fundamental Issues for EMR Data capture Data input Error prevention Data display –Flow sheet –Summaries and abstracts

Sep 13 Fall 05 Questions?? Comments!!